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Successful Management of Acute-onset Torticollis in a Giraffe
The Chiro.Org Blog
SOURCE: J Zoo Wildl Med. 2013 (Mar); 44 (1): 181-5
Liza I. Dadone, V.M.D., Kevin K. Haussler, D.V.M., D.C., Ph.D., Dipl. A.C.V.S.M.R., Greg Brown, D.V.M., Melanie Marsden, D.V.M., James Gaynor, D.V.M., Dipl. A.C.V.A., Dipl. A.A.P.M, Matthew S. Johnston, V.M.D., Dipl. A.B.V.P. (Avian), DellaGarelle, D.V.M.
Cheyenne Mountain Zoo, Colorado Springs, Colorado 80906, USA. ldadone@cmzoo.org
A 2-yr-old male reticulated giraffe (Giraffa camelopardalis reticulata) presented with severe midcervical segmental torticollis upon arrival as an incoming shipment. Despite initial medical management, the giraffe developed marked neck sensitivity, focal muscle spasms, and decreased cervical range of motion. Using operant conditioning to assist patient positioning and tolerance to cervical manipulation, a series of manually applied chiropractic treatments were applied to the affected cervical vertebrae in an effort to restore normal cervical mobility.
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 By Frank M. Painter, D.C. in Cervical Spine on May 15th, 2012 at 1:36 pm
Cervical Spine Trauma
The Chiro.Org Blog
Clinical Monograph 22
By R. C. Schafer, DC, PhD, FICC
The cervical spine provides structural stability and support for the cranium, and a flexible and protective column for movement and balance adaptation, along with housing of the spinal cord and vertebral arteries. It also allows for directional orientation of the eyes and ears. Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the cervical region.
BACKGROUND
Whether induced by trauma or not, cervical subluxation syndromes may be reflected in total body habitus. IVF insults, and the effects of articular fixations can manifest throughout the motor, sensory, and autonomic nervous systems. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the cervical spine, as may numerous brainstem disorders.
Common Injuries and Disorders of the Cervical Spine
Cervical spine injuries can be classified as:
- Mild (eg, contusions, strains);
- Moderate (eg, subluxations, sprains, occult fractures, nerve contusions, neurapraxias);
- Severe (eg, axonotmesis, dislocation, stable fracture without neurologic deficit); and
- Dangerous (eg, unstable fracture-dislocation, spinal cord or nerve root injury).
Spasm of the sternocleidomastoideus and trapezius can be due to strain or irritation of the sensory fibers of the spinal accessory nerves as they exit with the C2–C4 spinal nerves. The C1 and C2 nerves are especially vulnerable because they do not have the protection of an IVF. Radicular symptoms are rarely evident unless an IVD protrusion or rupture is present.
You may also enjoy our:
Chiropractic Rehabilitation Page and also the
Chronic Neck Pain and Chiropractic Page
Prevalence
Because of its great mobility, relatively small structures, and weight-bearing role, the cervical spine is a frequent site of severe spinal nerve injury and subluxation/fixations. A large variety of cervical contusions, Grade 1–3 strains and sprains, subluxations, disc syndromes, dislocations, and fractures will be seen as the result of trauma.
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By Frank M. Painter, D.C. in Cervical Spine on December 5th, 2011 at 5:10 pm
Sports Management:
Neck and Cervical Spine Injuries
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 22 from RC’s best-selling book:
“Chiropractic Management of Sports and Recreational Injuries”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 22: NECK AND CERVICAL SPINE INJURIES
Soft-Tissue Injuries of the Posterior Neck
Cervical Contusions, Strains, and Sprains
Contusions in the neck are similar to those of other areas. They often occur to the cervical muscles or spinous processes. Painful bruising and tender swelling will be found without difficulty, especially if the neck is flexed. Phillips points out the necessity of normally lax ligaments at the atlanto-axial joints to allow for normal articular glidding, thus making tonic muscle action the only means by which head stability is obtained.
Strains (Grades 1–3) or indirect muscle injuries are common, frequently involving the erectors. Flexion and extension cervical sprains are also common in sports (Grades 1–3), and usually involve the anterior or posterior longitudinal ligaments, but the capsular ligaments may be involved. In the neck especially, strain and sprain may coexist. Severity varies considerably from mild to dangerous. Anterior injuries are more common to the head and chest as they project further anteriorly, but a blunt blow from the front to the head or chest may result in an indirect extension or flexion injury of the cervical spine. Many cervical strains heal spontaneously but may leave a degree of fibrous thickening or trigger points within the injured muscle tissue. Residual joint restriction following acute care is more common in traditional medical care than under mobilizing chiropractic supervision.
Cervical sprain and disc rupture are associated with severe pain and muscle spasm and are more common in adults because of the reduced elasticity of supporting tissues. Pain is often referred when the brachial plexus is involved. Cervical stiffness, muscle spasm, spinous process tenderness, and restricted motion are common. When pain is present, it is often poorly localized and referred to the occiput, shoulder, between the scapulae, arm or forearm (lower cervical lesion), and may be accompanied by paresthesias. Radicular symptoms are rarely present unless a herniation is present.
Diagnosis and treatment are similar to that of any muscle strain-sprain, but concern must be given to induced subluxations during the initial overstress. Palpation will reveal tenderness and spasm of specific muscles. In acute scalene strain, tenderness and swelling will usually be found. When the longissimus capitis or the trapezius are strained, they stand out like stiff bands.
Extension Injuries. When the head is violently thrown backwards (eg, whiplash), the damage may vary from minor to severe tearing of the anterior and posterior ligaments. Severe cord damage can occur which is usually attributed to momentary pressure from the ligamentum flavum and lamina posteriorly, even without roentgenographic evidence. A facial injury usually suggests an accompanying extension injury of the cervical spine as the head is forced backward. Management of minor injuries requires reduction of subluxations, traction, physiotherapeutic remedial aid, a supporting collar for as long as postural muscles are inadequate for structural support, followed by graduated therapeutic exercises.
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By Frank M. Painter, D.C. in Cervical Spine on November 12th, 2011 at 12:00 pm
The Posterior Neck and Cervical Spine
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 5 from RC’s best-selling book:
“Symptomatology and Differential Diagnosis”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 5: The Posterior Neck and Cervical Spine
Introduction
With the important exception of neurologic and vertebral artery syndromes, most of the disorders witnessed in the posterior aspect of the neck are musculoskeletal conditions. Of particular significance are the symptom complexes of cervical arthritis, deformities, disorders of muscle tone, IVD syndromes, spondylosis, vertebral subluxation, tumors, and the effects of trauma. It is helpful to keep in mind that tumors of the cervical spine are usually secondary and that chronic degenerative disc disease and congenital anomalies may be asymptomatic for many years.
Functional Considerations
Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the neck. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the brachial plexus and cervical spine.
The gross mechanical function of the neck is determined by analysis of joint motion and muscle strength.
EVALUATING JOINT MOTION OF THE NECK
Gross joint motion is roughly screened by inspection during active motions. When a record is helpful, it is usually measured by goniometry. The prime movers and accessories responsible for voluntary joint motion in the cervical region are shown in Table 5.1.
EVALUATING MUSCLE STRENGTH OF THE NECK
Muscle strength is recorded as from 5 to 0 or in a percentage and compared bilaterally whenever possible. The major muscles of the neck, their primary function, and their innervation are listed in Table 5.2.
Structural and Neurologic Considerations
The healthy posterior neck provides stability and support for the cranium, a flexible and protective spine for movement, balance adaptation, and housing for the spinal cord and vertebral artery. From a biomechanical viewpoint, primary cervical subluxation syndromes may reflect themselves in the total habitus; from a neurologic viewpoint, insults may manifest throughout the motor, sensory, and autonomic nervous systems. Unlike the lumbar region, cervical disc herniations are not frequently associated with severe trauma; however, traumatic nerve root or cord compression has a high incidence in this area.
A general classification of musculoskeletal disorders of the neck is shown in Tables 5.3, and the function of the nerves of the cervical plexus and the brachial plexus is shown in Tables 5.4 and 5.5.
Anomalies and Deformities
Gross anomalies are rarely seen in chiropractic practice unless well adapted to the individual’s life-style. Those cases that have biomechanical significance vary in severity from minor to severe and occur multiply or singly. The cause is purely genetic transmission in about 35% of cases, and the remainder is due to environmental factors or a mixture of genetic and environmental factors.
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By Frank M. Painter, D.C. in Cervical Spine on July 28th, 2010 at 11:37 pm
Clinical Biomechanics: The Cervical Spine
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 7 from RC’s best-selling book:
“Clinical Biomechanics:
Musculoskeletal Actions and Reactions”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 7: CLINICAL BIOMECHANICS OF THE CERVICAL SPINE
This chapter considers those factors that are of biomechanical and related clinical interest imperative to the satisfactory evaluation of common or not infrequent cervical syndromes. The discussion assumes that the physician is skilled in taking a thorough clinical history and performing the basic physical, orthopedic, neurologic, and roentgenographic examination procedures. The kinesiology and kinematics of the neck, the effects and mechanisms of cervical trauma, and a number of clinical problems are discussed that are pertinent to the diagnosis and management of musculoskeletal cervical disorders.
General Aspects of Cervical Trauma
Blows to the head or neck may result in unconsciousness, but most blows do not. Rather, the effect is a “subconcussive” or “punch drunk” effect for a few moments. This state may be the effect of a severe blow to the head or the cumulative effects of many blows. It is assumed that the reader is well acquainted with the proper emergency procedures involved in head and neck trauma.
The anterior and lateral aspects of the neck contain a wide variety of vital structures that have no bony protection. Partial protection is provided by the cervical muscles, the mandible, and the shoulder girdle. After spinal injury, a careful neurologic evaluation must be conducted. Note any signs of impaired consciousness, inequality of pupils, or nystagmus. Do outstretched arms drift unilaterally when the eyes are closed? Standard coordination tests such as finger-to-nose, heel-to-toe, heel-to-knee, and for Romberg’s sign should be conducted, along with superficial and tendon reflex tests. For reference, the segmental functions of the cervical nerves are listed in Table 7.3.
Cervical spine injuries can be classified as being: (1) mild (eg, contusions, strains);
(2) moderate (eg, subluxations, sprains, occult fractures, nerve contusions, neurapraxias);
(3) severe (eg, axonotmesis, dislocation, stable fracture without neurologic deficit); and
(4) dangerous (eg, unstable fracturedislocation, spinal cord or nerve root injury).
Soft-Tissue Injuries of the Posterolateral Neck
CERVICAL CONTUSIONS
Contusions in the neck are similar to those of other areas. They often occur in the cervical muscles or spinous processes. Painful bruising and tender swelling will be found without difficulty, especially if the neck is flexed. They present little biomechanic significance unless severe scarring occurs.
DIRECT NERVE TRAUMA
Nerve trauma occurs from contusion, crushing, or laceration.
Neurapraxia.
Recovery of nerve contusion usually occurs within 6 weeks. Nerve contusion may be the result of either a single blow or through persistent compression. Fractures and blunt trauma are often associated with nerve contusion and crush. Peripheral nerve contusions exhibit early symptoms when produced by falls or blows. Late symptoms arise from pressure by callus, scars, or supports. Mild cases produce pain, tingling, and numbness, with some degree of paresthesia. Moderate cases manifest these same symptoms with some degree of motor and/or sensory paralysis and atrophy.
Axonotmesis. After nerve crush, recovery rate is about an inch per month between the site of trauma and the next innervated muscle. If innervation is delayed from this schedule or if the distance is more than a few inches, surgical exploration should be considered.
Neurotmesis. Laceration from sharp or penetrating wounds is less frequently seen than tears from a fractured bone’s fragments. Surgery is usually required. Stretching injury typically features several sites of laceration along the nerve and is usually limited to the brachial plexus.
Review the complete Chapter (including sketches and Tables)
at the ACAPress website |
By Frank M. Painter, D.C. in Cervical Spine on October 7th, 2009 at 10:46 pm
Motion Palpation of the Cervical Spine
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 3 from RC’s best-selling book:
“Motion Palpation”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 3: The Cervical Spine
This chapter describes the basic biomechanical, diagnostic, and therapeutic considerations related to motion palpation and the cervical spine. Emphasis will be on relating the general concepts previously explained about the chiropractic fixation-subluxation complex to specific entities that can be revealed by motion palpation and frequently corrected by dynamic chiropractic. Some aids to differential diagnosis are also included.
APPLIED ANATOMY CONSIDERATIONS
There are seven sites of possible “articular” fixation in the cervical spine. They are at the bilateral apophyseal joints, the bilateral covertebral joints, the superior and inferior intervertebral disc (IVD) interfaces, and the odontal-atlantal articulation (Table 3.1).
Table 3.1. The 27 Sites of Possible Spinopelvic Articular Fixation
| In the cervical spine (7 possible sites of fixation) | | Bilateral apophyseal joints | 2 | | Bilateral covertebral joints | 2 | | Superior and inferior IVD interfaces | 2 | | Odontal-atlantal articulation | 1 | | In the thoracic spine (8 possible sites of fixation) | | Bilateral apophyseal joints | 2 | | Superior and inferior IVD interfaces | 2 | | Bilateral costovertebral joints | 2 | | Bilateral costotransverse joints | 2 | | In the lumbar spine (4 possible sites of fixation) | | Bilateral apophyseal joints | 2 | | Superior and inferior IVD interfaces | 2 | | In the pelvis (8 possible sites of fixation) | | Bilateral superior sacroiliac joints | 2 | | Bilateral inferior sacroiliac joints | 2 | | Sacrococcygeal joint | 1 | | Pubic joint | 1 | | Bilateral acetabulofemoral joints | 2 |
The Apophyseal Joints of the Spine
Throughout the spine, paired diarthrodial articular processes (zygapophyses) project from the vertebral arches. The superior processes (prezygapophyses) of the inferior vertebra contain articulating facets that face somewhat posteriorly. They mate with the inferior processes (postzygapophyses) of the vertebra above that face somewhat anteriorly. Each articular facet is covered by a layer of hyaline cartilage that faces the synovial joint. The angulation of vertebral facets normally varies with the level of the spine and can be altered by wear and pathology.
In visualizing the motion of any joint, it is helpful to keep in mind that the hyaline-coated articulating surface is not the shape of the often flat bony surface exhibited on an x-ray film. Most apophyseal joints of the spine have a convex-concave shape.
Fisk states that the posterior joints of the spine are more prone to osteoarthritic changes than any other joint in the body: “Evidence of disc degeneration precedes this arthritis in the lumbar spine, but there is no such relationship in the cervical spine.” However, most authorities agree with Grieve that the presence of arthrotic changes in the facet planes does not, of itself, necessarily have any effect on ranges of movement, neither does the presence of osteophytosis.
Regional Structural Characteristics
Review the complete Chapter (including sketches and Tables)
at the ACAPress website |
By Frank M. Painter, D.C. in Cervical Spine on October 2nd, 2009 at 1:46 am
Physical Examination of the Neck and Cervical Spine
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 8 from RC’s best-selling book:
“Spinal and Physical Diagnosis”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 8: Physical Examination of the Neck and Cervical Spine
In general, the neck viscerally serves as a channel for vital vessels and nerves, the trachea, esophagus, spinal cord, and as a site for lymph and endocrine glands. From a musculoskeletal viewpoint, the neck provides stability and support for the cranium, and a flexible and protective spine for movement, balance adaptation, and housing of the spinal cord and vertebral artery. Cervical flexion, extension, and rotation contribute to one’s scope of vision.
From a biomechanical viewpoint, primary cervical dysarthrias may reflect themselves in the total habitus; from a neurologic viewpont, insults many manifest themselves throughout the motor, sensory, and autonomic nervous systems. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the brachial plexus and cervical spine. Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the neck.
Neck pain must be differentiated as to its date of onset and chronology, site and distribution, type (intermittent, constant), duration (acute, chronic), character (sharp, dull, lanciating), relation to posture (rest, occupation, recreation), and associated problems. Nonpharyngeal pain on swallowing may be traced to an anterior cervical spinal pathology such as bony protuberance or osteophytes, infection, mass or tumor. Pain is often referred to the neck from the TMJ, mandibular or dental infection, or sinus infection.
Inspection of the Neck
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